Lee Li-Yun, Chen Shu-Ching, Chen Wen-Cheng, Huang Bing-Shen, Lin Chien-Yu
Department of Nursing, China Medical University Beigang Hospital, Yunlin, Taiwan; and School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Head and Neck Oncology Group, Chang Gung Medical Foundation, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Feb;119(2):187-95. doi: 10.1016/j.oooo.2014.10.003. Epub 2014 Oct 15.
The aims of this study were to investigate the following in patients with head and neck cancer (HNC): (1) factors related to trismus that predict the development of trismus, (2) factors affecting quality of life and measurements of these factors, and (3) comparison of these findings in patients with and without trismus to evaluate the effects of trismus on quality of life.
This cross-sectional study included the questionnaires: the Hospital Anxiety and Depression Scale (HADS) - Depression Subscale, the Chewing Function Questionnaire (CFQ), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Head and Neck Cancer Module (EORTC QLQ-HN35). A scaled ruler was used to measure maximal intercisal opening (MIO).
Of the 104 patients in the study, 8.7% had clinical depression. The average MIO was 35.81 mm, and 47.1% of patients had trismus. Moderate levels of chewing dysfunction with regard to different types of food were noted. Lower body mass index, chemoradiotherapy treatment, longer time since treatment completion, and higher radiation dose were significantly associated with trismus. Such patients had significantly lower head and neck-specific quality of life in terms of social contact, sexuality, teeth, mouth opening, dry mouth, feeling ill, nutritional supplement, and weight loss.
Patients with trismus should be provided mouth opening exercises after treatment and programs to improve trismus and quality of life.
本研究旨在调查头颈癌（HNC）患者的以下情况：（1）与牙关紧闭相关且可预测牙关紧闭发生的因素；（2）影响生活质量的因素及其测量方法；（3）比较有和没有牙关紧闭的患者的这些结果，以评估牙关紧闭对生活质量的影响。
这项横断面研究采用了以下问卷：医院焦虑抑郁量表（HADS）-抑郁分量表、咀嚼功能问卷（CFQ）以及欧洲癌症研究与治疗组织生活质量问卷-头颈癌模块（EORTC QLQ-HN35）。使用直尺测量最大切牙间开口度（MIO）。
在该研究的104例患者中，8.7%患有临床抑郁症。平均MIO为35.81毫米，47.1%的患者存在牙关紧闭。观察到患者在不同类型食物方面存在中度咀嚼功能障碍。较低的体重指数、放化疗治疗、治疗结束后较长的时间以及较高的放疗剂量与牙关紧闭显著相关。这些患者在社交、性、牙齿、张口、口干、不适、营养补充和体重减轻等方面的头颈特异性生活质量显著较低。
牙关紧闭患者在治疗后应进行张口训练，并开展改善牙关紧闭和生活质量的项目。
